EOSS Assesses More Than Just Cardiometablic Risk

Readers of these pages will be quite familiar with the Edmonton Obesity Staging System (EOSS) that is increasingly used in clinical practice to stratify patients presenting with overweight or obesity in terms of actual health status (rather than just BMI).

Previous studies have shown that EOSS is a far better predictor of cardiovascular and overall mortality than BMI or waist circumference. However, its performance compared to other measures of cardiometabolic risk is not known.

Now, a study by Keisuke Ejima and colleagues, published in Obesity, compares the predictive value for mortality and years of life lost between EOSS and Cardiometabolic Disease Staging (CMDS) in NHANES.

Whereas CMDS is scored based on the the presence of cardiometabolic risk factors, EOSS is scored on a much broader range of parameters including mental, medical, and functional health.

In their analyses, both CMDS and EOSS consistently identified individuals at higher mortality risk. Thus, the median years of life lost for EOSS scores 2 and 3 (low to high risk) for a reference person were 1.19 and 6.76 years. Those for CMDS scores 1, 2, 3, and 4 (low to high risk) were 1.53, 2.90, 3.91, and 8.51 years. 

In their interpretation of these findings, the authors discuss that CMDS may have greater clinical utility not only because it appears to have better discriminatory power but also uses fewer items to risk stratify.

To me the findings are not surprising and if all you are interested in is mortality, then clearly all you need to calculate is CMDS – which was specifically designed and validated to assess cardiometbolic risk.

However, in clinical practice, mortality is only one of the parameters of interest. Many may argue that other parameters including mental health, chronic pain, or even just quality of life may be as, if not more important to patients, than whether or not they live a couple of years longer or not. Thus, clinical decisions around treatments need to take more into account than just cardiometabolic risk.

It is for this very reason that EOSS was conceptualised as a much broader assessment of health than just cardiometabolic risk.

Thus, it may well be that both staging systems may find their place in clinical practice – CMDS for clinicians and patients who prefer a narrower focus on mortality risk and life expectancy, EOSS for clinicians and patients who prefer to consider a broader definition of health that includes other medical issues (e.g. chronic pain, fertility issues, etc.), as well as mental and functional health.

@DrSharma
Edmonton, AB